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Daring discourse: should the ESP block be renamed RIP II block?
P A Lonnqvist1, Manoj Kumar Karmakar2, Jonathan Richardson3
1Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden Per-Arne.Lonnqvist@ki.se.
Regional Anesthesia and Pain Medicine
|September 15, 2020
Summary
The erector spinae plane block (ESPB) shows a concerning lack of evidence, similar to the past interpleural nerve blockade. Researchers caution that ESPB may become obsolete due to insufficient scientific support for trunk surgeries.
Area of Science:
- Anesthesiology
- Regional Anesthesia
- Pain Management
Background:
- Interpleural nerve blockade was widely used for trunk procedures despite limited evidence.
- Interest waned as evidence failed to support its efficacy, leading to its decline.
- A similar trend may be emerging with the erector spinae plane block (ESPB).
Purpose of the Study:
- To critically evaluate the evidence base for the erector spinae plane block (ESPB).
- To compare the current evidence for ESPB with established regional anesthetic techniques.
- To discuss the potential trajectory of ESPB based on historical parallels.
Main Methods:
- Review of PubMed literature regarding ESPB since 2019.
- Analysis of emerging meta-analysis data on ESPB efficacy.
- Comparative assessment of evidence supporting ESPB versus other nerve blocks.
Main Results:
- Significant increase in ESPB publications since 2019, but with a questionable evidence base.
- Lack of a clearly defined mechanism of action for ESPB's efficacy in anterior trunk surgeries.
- Emerging data raise skepticism about ESPB's utility in major thoracic and abdominal surgery.
Conclusions:
- The ESPB currently lacks robust evidence comparable to established regional anesthetic techniques.
- Concerns exist regarding its mechanism of action and efficacy for anterior trunk procedures.
- ESPB may follow the path of interpleural nerve blockade, becoming less utilized due to insufficient evidence, potentially earning the name 'RIP II block'.
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